{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:19:19Z","timestamp":1787750359421,"version":"build-2784847793"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Close to 50% of patients with Graves\u2019 disease have associated ocular involvement, of which dysthyroid optic neuropathy (DON) is prevalent in 3\u20135% of patients. The response to intravenous glucocorticoids in DON is dependent on early diagnosis. The purpose of this study was to assess the efficacy of various radiological indices (Barrett\u2019s index, Nugent index) in predicting DON and treatment response or relapse in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a retrospective study that included patients presenting with clinically active Graves\u2019 orbitopathy (GO) between January 2005 and June 2021 to our hospital. Demographics, clinical presentation, biochemical parameters, risk factors, comorbidities, and radiology data were collected and analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Fifty-eight orbits from 29 patients were assessed. A higher Barrett\u2019s index was associated with DON (61.4% vs 51.1%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03), lower glucocorticoid responsiveness (63.7% vs 54.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.043), and the need for surgical intervention (62.85% vs 49.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). Nugent index \u22651 was significantly associated with sight-threatening GO (48.2% vs 22.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02) and higher glucocorticoid requirements (54.8% vs 23.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04). A cut-off of 58% for the Barrett\u2019s index (AUC 0.705, 95% CI 0.545\u20130.865) was suggestive of DON, with a sensitivity of 60% and a specificity of 68.8%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This is the first comprehensive assessment of patients with GO among Indians with active disease. The Barrett\u2019s index threshold was defined in our population to facilitate objective early identification of DON. This index shows promise for early diagnostic sub-categorisation in DON among Indians; however, its low sensitivity limits its widespread use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijem.ijem_1000_25","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T14:02:10Z","timestamp":1782482530000},"page":"251-257","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Dysthyroid Optic Neuropathy in Graves\u2019 Orbitopathy: Insights from a Single Centre and Limitations of the Radiological Indices"],"prefix":"10.4103","volume":"30","author":[{"given":"Khushboo","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alen Antony","family":"Joy","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhavi","family":"Veerappan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sindhu S.","family":"Rallapalli","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayanthi","family":"Peter","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Sahu","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhavi","family":"Kandagaddala","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hesarghatta S.","family":"Asha","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitin","family":"Kapoor","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kripa E.","family":"Cherian","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Rebekah","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Christian Medical College Vellore, Vellore, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix K.","family":"Jebasingh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Diabetes and Metabolism, Christian Medical College Vellore, Vellore, Tamil Nadu, India"},{"name":"Austin Health, The University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihal","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, 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